- Department of Anthropology, Texas State University, San Marcos, Texas, USA
- Columbia University Mailman School of Public Health, New York, New York, USA
- Johns Hopkins Center for Health Security and Department of Environmental
Health and Engineering, Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland, USA
ABSTRACT
Effective communication about medical countermeasures—including drugs, devices,
and biologics—is often critical in emergency situations. Such communication, however, does not just happen. It must be planned and prepared for. One mechanism to
develop communication strategies is through the use of prospective scenarios, which
allow readers the opportunity to rehearse responses while also weighing the implications of their actions. This article describes the development of such a scenario: The
SPARS Pandemic 2025–2028. Steps in this process included deciding on a time frame,
identifying likely critical uncertainties, and then using this framework to construct a
storyline covering both the response and recovery phases of a fictional emergency
event. Lessons learned from the scenario development and how the scenario can be
used to improve communication are also discussed.
KEYWORDS: prospective scenario, medical countermeasures, risk communication,
public health emergency, crisis communication
Medical countermeasures (MCM)—including drugs, devices,
and biologics (e.g., vaccines)—often play critical roles in curtailing the impacts of natural disease outbreaks as well as chemical,
Nicholson School of
Communication and Media
University of Central Florida
www.jicrcr.com
JOURNAL OF INTERNATIONAL CRISIS AND RISK
COMMUNICATION RESEARCH
2020, VOL 3, NO 1, 71–102
https://doi.org/10.30658/jicrcr.3.1.4
CONTACTS Monica Schoch-Spana, PhD • E-mail: mschoch@jhu.edu • Johns Hopkins Center for Health
Security, 621 East Pratt Street, Suite 210, Baltimore, MD 21202
© 2020 by Journal of International Crisis and Risk Communication Research. All rights reserved.
71
72 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
biological, radiological, or nuclear (CBRN) incidents (Courtney
& Sadove, 2015). It is not uncommon for members of the public,
however, to misuse or hesitate to take recommended MCM (Liu
et al., 2017; Quinn et al., 2008; Steelfisher et al., 2011). New and
unfamiliar technology, an accelerated regulatory approval process,
or discordant expert views may heighten perceived risks of MCM,
leading to public aversion to the countermeasure and/or diminished public trust in MCM regulators or recommenders (Belongia
et al., 2005; Carlsen & Glenton, 2016; Henrich & Holmes, 2011).
In other cases, strong feelings of vulnerability in an emergency situation may prompt persons to demand unnecessary MCM, protest their lack of access to MCM with limited availability, and/or
use an excessive amount of prescribed MCM (Dart et al., 2015;
Durigon & Kosatsky, 2012; Whitcomb et al., 2015). In still other
situations, certain social groups may have limited access to MCM
because some institutions are still in the process of learning how
culture, race, language, and citizenship status produce barriers to
health information sharing (Lin et al., 2014; Uscher-Pines et al.,
2011). To mitigate all of these issues and ensure proper and timely
use of MCM, good communication is key.
From 2014 to 2016, the Center for Health Security undertook
a research project to catalog MCM communication “dilemmas”
(in the broad sense of a problem) in emergency situations and
provide practical and strategic recommendations on how better
to obtain desired population health outcomes through improved
communication. The principal product was a casebook featuring
recent health crises (e.g., 2014–2015 West Africa Ebola outbreak
and 2011 Fukushima nuclear plant accident) that helped to illustrate the principles and conditions for effective MCM communication (Schoch-Spana et al., 2016).
Much of the practice-oriented literature relies upon real crises to illustrate successful (or failed) approaches to risk and crisis
communication (e.g., Centers for Disease Control and Prevention [CDC], 2018; Ulmer et al., 2017). The project team similarly
used past health emergencies to advance understanding of how
communication enables appropriate public use of MCMs, because
case studies have compelling benefits for learning: People reason effectively through analogy and not just abstract principles,
The SPARS Pandemic 2025–2028 73
contextualization makes broader principles meaningful and memorable, and cases promote reflective thinking and reinforce users’
abilities to apply that knowledge in novel settings (Allchin, 2013;
Epling et al., 2003).
Leveraging the same didactic qualities as retrospective cases
(Varum & Melo, 2010), the project team subsequently developed
a fictionalized prospective scenario—The SPARS Pandemic 2025–
2028—to further prepare users for MCM-related risk and crisis
communication dilemmas on the horizon. A scenario is an “analytically coherent” and “imaginatively engaging” story about a possible future state (Bishop et al., 2007) that spurs users to envision
and exercise their role in shaping potential outcomes (Borjeson
et al., 2006; Mahmoud et al., 2009; Wilkinson & Eidinow, 2008).
Outlined in this paper and available in full online (Schoch-Spana
et al., 2017), the SPARS scenario is intended to help authorities
better anticipate MCM emergency communication dilemmas,
understand the larger contexts, practice effective responses, and
develop acuity and agility for addressing unforeseen problems.
The SPARS Pandemic 2025–2028 features MCM communication
dilemmas both of the enduring and emerging kind—especially
those in relation to evolving information and communication
technologies (ICT).
Benefits of Scenarios and Simulations in Preparing for
Disasters and Epidemics
The forward-looking SPARS scenario is a tool meant to prompt
readers to imagine the dynamic and oftentimes conflicted circumstances in which MCM emergency communication takes place. By
engaging readers with a rigorous, simulated health emergency the
scenario provides opportunities for readers to mentally “rehearse”
responses while also weighing the implications of their actions
(Borjeson et al., 2006). Apart from testing out responses to foreseeable events, the scenario also provides readers opportunities
to consider potential measures in today’s environment that might
avert comparable problems or classes of problems in the future;
that is, consider how to create a preferred future (Bishop et al.,
2007; Borjeson et al., 2006; Mahmoud et al., 2009; Wilkinson &
Eidinow, 2008).
74 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
Producing coherent and imaginative narratives about the
future to inform decision-making in the present is an approach to
planning and risk management that businesses, think tanks, governments, and non-governmental organizations have embraced
for a half century or more, and a wide range of aims, applications, and techniques have evolved (Bishop et al., 2007; Varum
& Melo, 2010; Wilkinson & Eidinow, 2008). In the case of a lowprobability high-consequence event like a pandemic or CBRN
incident in which MCM may be deployed, scenario development
provides a way—absent an actual emergency—for stakeholders to
characterize specific impacts (based on the accepted science), create a shared vision of the threat, weigh alternatives futures with or
without risk-reducing interventions, and stimulate action (Earthquake Engineering Research Institute [EERI], 2019; Preuss & Godfrey, 2006). Earthquake and bioterrorism scenarios, for instance,
have played important roles in motivating creative thinking about
the need for novel policies and programs and in mobilizing new
constituencies around seismic risk reduction (National Research
Council [NRC], 2011) and public health emergency preparedness
(Hamilton & Smith, 2006; O’Toole et al., 2002), respectively.
Scenarios that depict an unfolding crisis are valuable tools that
can heighten awareness about complex hazards and also enable
practical training for the management of disasters and epidemics
through exercises (European Centre for Disease Prevention and
Control [ECDC], 2014; Federal Emergency Management Agency
[FEMA], 2019; World Health Organization [WHO], 2018).
Discussion-based exercises (often called tabletop exercises) help
participants, typically decision-makers, become more familiar
with emergency plans and procedures, individual and organizational roles and responsibilities, and special challenges posed by
a particular threat to public health and safety. By contrast, operation-based exercises (such as drills, functional exercises, and field
exercises) attempt to incorporate, to a lesser or greater degree, the
front-line personnel, equipment, and physical spaces expected to
be in play during an actual emergency (FEMA, 2019; Skryabina
et al., 2017). A majority of studies on the effectiveness of training in emergency risk communication, in particular, conclude
The SPARS Pandemic 2025–2028 75
that the impacts of tabletop exercises and simulation for training
include enhanced awareness, readiness, and knowledge (Miller
et al., 2017).
Social Media Challenges/Opportunities for Health and MCM
Communication
Like the previously mentioned earthquake and bioterrorism scenarios, the SPARS scenario is meant to prepare risk and crisis
communicators for future emergencies, and in particular the complex conditions that rapidly-evolving ICT, including social media,
are now generating around medicine/public health generally and
MCM specifically.
ICT use, including text, illustrations, photo, audio, videos, and
diagrams communicated through blog posts, instant messages,
video chats, and social network platforms, is now widespread and
often used for health-related activities. Among members of the
public, a 2010 survey by the Pew Research Center, for instance,
showed that 8 in 10 internet users look online for health information, making it the third most popular online activity in the
U.S. (Fox, 2011). Likewise, practitioners, public health officials,
and other health experts are increasingly turning to ICT—which
provides a means to reach the broadest possible population in the
fastest, easiest, and least expensive manner (Hinton & Hjorth,
2013)—for a variety of purposes. Clinician-to-patient and peerto-peer communication, investing individual patients in their own
care, information exchanges among diverse healthcare and public health stakeholders, and detecting and managing disease outbreaks have been transformed through ITC (Charles-Smith et al.,
2015; Grajales et al., 2014; Kreps & Neuhauser, 2010; Rice & Sara,
2018). While this situation may appear overwhelmingly positive,
some aspects of ITC use and its popularity remain problematic.
First, ITC use has altered the dynamics between health experts
and the patients and populations they serve (Hawn, 2009). Social
media in particular has provided a mechanism for laypersons to
readily share their health-related experiential knowledge with
each other, thus dislodging the centrality of health professionals’
authoritative knowledge in people’s decision-making and behavior
(Hawn, 2009; Househ et al., 2014).
76 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
Second, ITC can, and is, used to spread false information.
Wolfe and associates (2002), for example, found that 32% of antivaccine websites surveyed included pictures of “menacing needles”
and 23% had pictures of children reported to have been harmed or
killed by vaccines. As parents come across these images and their
associated stories this can lead parents to place greater emphasis
on personal and emotional experience rather than scientific evidence. Referred to as false consensus bias in the social psychology
literature, parents may then hesitate to vaccinate or reject vaccines
for their children altogether.
What is particularly challenging in regard to social media is
that such images and negative stories tend to have a greater impact
than facts and positive messages. In their research of vaccinationrelated YouTube videos, for example, Keelan and associates (2007)
found that while the majority (48%) of the 153 identified videos promoted vaccination and only 32% were negative toward
vaccination, the most liked and viewed were the ones with negative content. The lowest rated and watched videos were provaccination public service announcements.
These positive and negative aspects of ITC, in turn, influence
what practitioners and the broader public understand about MCM
safety and efficacy, thus presenting new challenges and opportunities for crisis and risk communicators. Medication users, for example, are increasingly sharing personal knowledge and experience
of drug benefits and risks via online disease support networks,
patient and drug forums, and microblogging (Matsuda, 2017;
Sloane et al., 2015). Through social media, these individuals can
find both practical information and a sense of community, while
drug safety professionals have a new, rich data source with which
to mine for potential evidence of adverse events, supplementing
uneven healthcare provider reports (Edwards & Lindquist, 2011;
Inch et al., 2012).
At the same time, great potential exists for the public to
encounter misleading or dangerous information about pharmaceuticals, as non-expert consumers deliver their own drug product
testimonials and illegal online pharmacies promote their services
via social media (Tyrawski & DeAndrea, 2015). Misinformation is
proving especially challenging in connection with vaccines where
The SPARS Pandemic 2025–2028 77
social media users encounter disproportionate negative reporting
and images, are more swayed by personal narratives about vaccination’s adverse effects than the science, and tend to judge disparate ideas about vaccines as equally valid, regardless of expertise
(Guidry et al., 2015; Kata, 2012; Poland et al., 2009; Witteman &
Zikmund-Fisher, 2012). Thus, in this current ITC-rich environment, good communication, and good training for effective communication, is critical.
Methods
To develop the SPARS scenario a project team with expertise in a
variety of areas, including epidemiology, public health preparedness, risk communication, and the biological and social sciences,
was assembled. Utilizing these diverse perspectives, the team used
a combination of the inductive and deductive heuristics delineated
by Ogilvy and Schwartz (2004) to develop the scenario premise
(Figure 1). This process began with selecting the timeframe for the
scenario—the years 2025–2028. These dates, which were 10–13
years in the future at the time, were chosen to provide a timeline
that allowed the development of future possibilities, but was not
so far in the future as to make the scenario become a work of science fiction. After the timeframe was established, the project team
turned to the focal question: What emergency communication
issues around MCM are most likely to exist 10 years from now?
To begin answering this question, the project team considered the key economic, environmental, political, social, and technological factors they felt were likely to emerge by 2025. Factors
considered by the project team included prominent ones such as
technological advances like the proliferation of tools to access the
internet, increased use of the internet for things like social media
and telemedicine, greater political and social polarizations, changing demographics in the United States including an aging baby
boomer population, and climate change and urbanization that
could result in the (re)emergence of zoonotic diseases.
After careful discussion of each of these factors, which included
consideration of existing literature and theoretical approaches, the
team considered which factors seemed inevitable given present
78 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
FIGURE 1 The scenario generation process, adapted from Ogilvy and
Schwartz (2004).
1 – Identify focal issue and
time frame
2 – Brainstorm a list of “key
drivers”
3 – Sort “drivers” into
“predetermined trends” and
“critical uncertainties”
4 – Select top 2 “critical
uncertainties” and build 2×2
scenario matrix
5 – Select 1 of the 4 futures
and elaborate on a complete
storyline
Deepen the plot through
systems thinking
Tell a story with a beginning,
middle, and end
Create characters
Employ standard plot lines
6 – Re ne the plot through an
iterative process of re ection,
research, and revision
7 – Explore the strategic
implications of the scenario
Single out a key decision or a strategic
uncertainty that has long-range consequences
important to the organization
Consider notable forces shaping and
in uencing the focal issue: social,
technological, economic, natural, political
Distinguish inevitable trends that will play out
the same no matter what versus important
trends whose impacts are unsure
Reduce each critical uncertainty to an axis
with polar cases at each extremity; overlay
the 2 axes and produce 4 futures to explore
Think of critical events, then delve into underlying patterns and structures that these events
signal; use diagrams to see how forces interact
Capture time and causality dimensions; rst
this, then that; generate a series of headlines
describing events over the course of the scenario
Personify the magnitude and direction of
change by using real or iconic gues
Build on common narratives (“winners and
losers” and “David and Goliath”)
Return to initial focal issue to determine
gaps, vulnerabilities, options facing the
organization
The SPARS Pandemic 2025–2028 79
conditions and which were the most likely to impact the direction
of the scenario. From this process, two critical uncertainties were
identified: the extent of access to information technology, that the
team felt was inevitable, and the degree of fragmentation among
populations along social, political, religious, and cultural lines,
which the team felt would lead to novel communication issues. The
project team then used these uncertainties to construct a scenario
matrix illustrating the four possible futures that could be shaped
by these trends (Figure 2). After careful consideration, the team
ultimately chose the “echo-chamber”—a world comprised of isolated and highly fragmented communities with widespread access
to information technology—as the future in which the prospective
scenario would take place.
FIGURE 2 Final Scenario Framework: Four possible futures in which the
SPARS pandemic unfolds.
Unbridled access and openness to information technology (including social
media)
Isolated
communities,
social
fragmentation
“Echo-chamber” “UN Security
Council”
Diverse but
integrated
communities,
“melting pot” “Solitary
Confinement”
“Shangri-La”
Erratic, unequal access to information technology (including social media)
“Echo-Chamber”—a technologically savvy, plugged in, but fragmented
society in which groups that hold diverse worldviews consume information
that continues to validate their own positions, allowing them to live in their
own mental bubble; government agencies and citizens alike have ready
access to all the latest informational tools.
“Solitary Confinement”—a society (including general population and public
sector) with an uneven access to informational technology (due to lack
of net neutrality, uneven infrastructure) that isolates differently minded
communities.
“UN Security Council”—a technologically savvy, plugged in society where
diversity reigns, but difference and tolerance are socially valued, and where
information flows freely across different groups.
“Singapore”—a melting pot society, with peaceful co-existence of differently
minded groups, but uneven levels of access to information technology.
80 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
From this point, scenario-specific storylines were developed,
drawing on the subject matter expertise of the project group,
interviews with expert working group (EWG) members associated
with the larger project, historical accounts of past MCM crises,
contemporary media reports, and scholarly literature in sociology,
emergency preparedness, health education, and risk communication. This process allowed the project team to identify expected
and new communication dilemmas to include in the scenario. As
one example of this, the project team considered how the internet
and social media affect the social dynamics of health communication. Using the theory of false consensus bias and the findings on
vaccination in social media (described previously in the literature
review section), the project team identified specific communication dilemmas to include in the scenario. One of these involved
responding to a particularly emotional video that was widely
spread via social media and then maintained in the public view for
months afterward by teenagers who enjoyed the shock value of the
images. This specific case, titled “Going Viral,” is presented later in
this paper.
Once different dilemmas were identified, the team considered
how the different storylines could reasonably fit together and what
characters were necessary in order for these events to occur. An
outline for the scenario was then constructed using newspaper
and other social media headlines as markers for key events; in
many instances, these remained in the scenario in order to introduce the different dilemmas. Finally, the entire storyline was written in draft form as if the SPARS outbreak had occurred in the
recent past, allowing some outcomes and conclusions to be drawn
within the scenario.
From this point, scenario development entailed a recursive
process of continued research and analysis by the project team,
review and feedback from EWG members (summer 2015), and
two rounds of external review by authorities on risk communication and the MCM enterprise (four individuals in fall 2015, three
individuals in summer 2017). Comprising the project EWG were
risk and crisis communication scholars; MCM developers, producers, and regulators; practitioners in medicine, public health,
The SPARS Pandemic 2025–2028 81
and pharmacy science; and experienced public health emergency
managers at all levels of government. Revisions were made after
each review in order to increase the accuracy and usefulness of the
material presented in the scenario.
The final product, referred to hereafter as the SPARS scenario,
is not intended to be a crystal ball of things to come; rather, it is
meant to serve as a plausible narrative that illustrates a broad range
of serious and frequently encountered challenges in the realm of
risk and crisis communication. To increase the usefulness of the
scenario, each response- and recovery-phase dilemma is followed
by food for thought questions that are meant to prompt readers,
reading as individuals or in training groups, to consider how they
might respond to similar situations or how they might prevent
similar problems or classes of problems from occurring in the first
place. Like the studies of scenario-driven exercises (Skryabina et
al., 2017) show, including those featuring emergency risk communication (Miller et al., 2017), the SPARS scenario is intended to
prepare users for mitigating public health emergencies and managing MCM communication dilemmas more effectively. In the
following sections, we outline the scenario environment and how
the fictional outbreak begins. We then provide excerpts of two
dilemma sections as examples of the larger document.
The SPARS Scenario: An Introduction
Scenario Environment
The setting of SPARS is the world in 2025–2028. For this time
period, the project team imagined a world that is simultaneously
more connected and yet more divided. There is nearly universal access to wireless internet for even the poorest persons in the
United States. Additionally, technological innovations and competition between technology companies have made an even wider
range of information technology readily available to all. Despite
the possibilities for these advancements to facilitate broad communication between individuals and communities, the project team
also envisioned a future where many have chosen to self-restrict
the sources they seek for information, often electing to interact
82 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
only with those whom they agree with on significant issues. This
trend increasingly isolates cliques from one another, making communication across and between these groups more difficult.
In relation to MCM communication more specifically, government agencies like the CDC have increasingly adopted social
media technologies, including long-existing platforms such as
Facebook, Snapchat, and Twitter, as well as emerging platforms
like ZapQ—an interface that enables users to aggregate and
archive media content from other platforms and communicate
with cloud-based social groups based on common interests and
current events. Federal and state public health organizations have
also developed agency-specific applications and ramped up efforts
to maintain and update agency websites.
Challenging this technological grip, however, are the diversity
of new platforms and the speed with which social media communities evolve. Moreover, while technologically savvy and capable,
these agencies still lag in terms of their “multilingual” skills, cultural competence, and ability to be present on all forms of social
media. These agencies also face budget constraints, which complicates their efforts to improve public communications efficiency
and effectiveness by increasing their presence in existing and
emerging social media platforms.
SPARS
After much consideration of possible emergency situations that
would require MCM use, the project team decided on setting the
storyline around a novel coronavirus that caused a mild, flu-like
disease in most instances, but pneumonia and/or hypoxia requiring hospitalization and extensive medical treatment in a small
minority of cases. The project team named this fictional pathogen
the St. Paul Acute Respiratory Syndrome Coronavirus, or SPARS
for short, because in the scenario it is first identified in St. Paul,
Minnesota.
Two features of this disease are important to note because they
impact how the storyline of the scenario plays out, as well as some
of the communication dilemmas that occur. First, the project
team decided to make SPARS have an extended incubation period
The SPARS Pandemic 2025–2028 83
(7 to 10 days) but a short latent period (4 to 5 days). This complicates the scenario because infected persons in the story are capable
of spreading the virus for up to 6 days before showing symptoms
of the disease themselves. This feature of SPARS makes isolation
procedures in the scenario, like urging people to stay home if
they think they might be sick, less effective than what is typically
expected for airborne pathogens and thus introduces novel dilemmas in the storyline. Second, the project team decided to make the
morbidity and mortality from SPARS both significantly higher in
children than adults, and among pregnant women and those with
chronic respiratory conditions. This parallels disease characteristics associated with past disease outbreaks, including the H1N1
pandemic, and allowed for some communication dilemmas from
the past to be revisited under different future circumstances.
In all, the SPARS scenario provides 19 specific storylines, and
an associated 23 communication dilemmas for readers to consider.
An outline of the entire storyline is available in Table 1, and a list
of the communication dilemmas provided in the scenario can be
found in Table 2. The following sections provide excerpts of two
dilemmas included in the scenario as well as their associated communication dilemmas and food for thought questions.
TABLE 1 Timeline of Events in the “SPARS Pandemic 2025–2028”
Scenario
2025
October The first US deaths occurred due to SPARS. Initially, these
deaths were thought to have been caused by influenza.
November Cases of SPARS were reported across Minnesota and in six
other states.
Thanksgiving holiday travel and Black Friday shopping
facilitated spread of SPARS beyond the Midwest (26 states
and multiple other countries by mid-December).
The WHO declared the SPARS pandemic to be a Public Health
Emergency of International Concern.
December No treatment or vaccine for SPARS existed, but there was
some evidence that the antiviral Kalocivir could be effective
as a therapeutic.
84 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
A proprietary vaccine developed and manufactured by a
multinational livestock conglomerate (GMI) was proposed
as a potential foundation for a human vaccine. The vaccine
was developed to combat an outbreak of a similar respiratory
coronavirus in hooved mammal populations in Southeast
Asia, but the vaccine had not been licensed by any regulatory
authority or tested in humans. There were concerns over
potential side effects.
2026
January The US government contracted CynBio to develop and
produce a human SPARS vaccine based on the GMI animal
vaccine.
The HHS Secretary invoked the Public Readiness and
Emergency Preparedness Act (PREP Act) to provide liability
protection for the vaccine manufacturer and providers.
Congress authorized and appropriated emergency funds
under the PREP Act to provide compensation for potential
adverse side effects from the vaccine.
Following reports of Kalocivir’s limited success in treating
patients with severe SPARS infections, the FDA issued an
Emergency Use Authorization (EUA) for the antiviral. Kalocivir
had been evaluated as a therapeutic for SARS and MERS,
and several million doses were maintained in the SNS, which
could be deployed as necessary while production capacity
was established to meet demand.
The FDA, CDC, and NIH provided seemingly conflicting
communications regarding the safety and efficacy of
Kalocivir.
In the United States, public anxiety around SPARS resulted in
extensive use of Kalocivir, frequent self-reporting of SPARS
symptoms, and a surge in demand for medical care.
By late January SPARS was detected in 42 countries and all US
states.
February A lack of cultural competency in FDA and other
governmental communication became apparent among
various ethnic groups in the United States.
A video of a 3-year-old vomiting and fainting after taking
a dose of Kalocivir was widely and rapidly spread via social
media, strengthening opposition to the EUA.
The SPARS Pandemic 2025–2028 85
The UK Medicines and Healthcare Products Regulatory
Agency and the European Medicines Agency jointly
authorized the emergency use of a new antiviral, VMax, in the
United Kingdom and throughout the European Union. Some
Americans attempted to gain access to VMax online or by
traveling to Europe.
April The CDC publicized an updated (and significantly lower) case
fatality rate in the United States; the perception of lesser risk
triggered a drop in public interest.
May Production of Corovax, the SPARS vaccine produced by
CynBio, was well underway.
Federal agencies initiated a communications campaign using
well-known public figures with mixed results. Polls indicated
a 15–23% increase in SPARS and Kalocivir knowledge
nationwide. Hip-hop icon BZee had success promoting
public health messaging with an online video clip, but he
lost credibility when he compared volunteers for Corovax
trials with “volunteers” from the Tuskegee syphilis study.
Similarly, former President Bennett provided a non-committal
response when asked if she would want Kalocivir for her new
grandson.
Public health agencies discovered that a relatively new social
media platform, UNEQL, was being used as a primary means
of communication in college-aged populations.
June Corovax entered the final stage of its expedited review, and
production capacity was increased. Ten million doses were
expected to be available by July with fifty million more in
August.
The CDC Advisory Committee on Immunization Practice
(ACIP) announced vaccine priority groups. Healthcare
providers were not included as a priority, inciting protests by
doctors and nurses across the country.
In order to prioritize distribution of limited Corovax supply,
the federal government requested that states report
summary information for patient electronic health records
(EHRs) to estimate the number of individuals in high-risk
populations. This effort was met with resistance from the
public, who protested the federal government accessing their
private medical information.
86 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
July A week prior to initiating the nationwide vaccination
program, damage to a power grid in the Pacific Northwest
resulted in a widespread power outage that lasted two
weeks. State and local public health agencies initiated
communications programs using posters and flyers to
promote the vaccination program in the absence of
electronic media.
Social media efforts across the country promoted the
vaccination campaign, and crowdsourced data helped to
increase efficiency in distributing the vaccine.
August The Corovax vaccination program met resistance from several
groups: alternative medicine proponents, Muslims, African
Americans, and anti-vaccination activists. Initially operating
independently, these groups banded together via social
media to increase their influence.
September Japan announced that it would not approve Corovax for
use in Japan in favor of developing and producing its own
vaccine.
October College students predominantly on the East and West coasts
staged protests against the unequal global availability of
Corovax. Vaccination rates among these students were below
average for college students in other areas of the country.
November The anti-anti-vaccine movement, formed in the wake of the
2015 measles outbreak in the United States, reignited their
efforts to combat the anti-vaccination super-group. The
FDA, CDC, and other federal agencies also redoubled their
communications efforts to promote the Corovax campaign.
An increasing number of post-SPARS pneumonia cases were
reported across the country.
December The nationwide vaccination program was expanded beyond
the initial priority populations to include the rest of the
country.
Federal agencies initiated a vaccination communication
program involving targeted online advertisements.
2027
February Post-SPARS pneumonia cases stressed inventories of
antibiotics across the country. The HHS Secretary authorized
distribution of the oldest lots of antibiotics from the SNS to
supplement the antibiotic supply nationwide.
Tests of antibiotics in the SNS inventory determined that 94%
of the remaining antibiotics in the oldest lots maintained
The SPARS Pandemic 2025–2028 87
sufficient potency. Tests conducted in August 2026 provided
the basis for extending the expiration of these lots from 2027
to 2029.
March Rumors spread via traditional and social media that the
government was dispensing expired antibiotics.
Alyssa Karpowitz, a leader in the natural medicine movement,
sought medical care at an emergency department after
natural remedies failed to resolve her son’s bacterial
pneumonia. After successful treatment with proper
antibiotics from the SNS supply, she touted the benefits of
“expired” antibiotics in her social media circles.
April Crowd-sourced and independent epidemiology analysis of
Corovax side effects conflicted with official federal reports.
The independent analyses gained popularity in traditional
and social media due to visual presentation and interactive
content. Government attempts to respond with data and
press releases largely failed.
May Reports of Corovax side effects began to gain traction. Several
parents of children who experienced neurological symptoms
after receiving the vaccination sued the federal government
and CynBio. The lawsuit was dropped when they learned of
compensation funds available through the PREP Act and the
National Vaccine Injury Compensation Trust Fund.
November Initial reports of long-term side effects of the Corovax
vaccine emerged. These reports arose primarily from those
in the initial priority (high-risk) populations and were few
in number. With little available data and numerous preexisting conditions, initial studies were unable to identify a
statistically significant association with any long-term effects.
Claims for compensation were placed on indefinite hold until
further data could be gathered and analysis completed.
In response to public demand for long-term side effect
compensation, the HHS Secretary invited Congress to
conduct an independent investigation of the federal
compensation process to alleviate concerns of impropriety.
The public and media pressured Congress to increase the
funds authorized for compensation under the PREP Act.
2028
August The SPARS pandemic was officially declared to be over;
however, experts remain concerned about domestic animal
reservoirs and the potential for future outbreaks.
88 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
TABLE 2 Emergency Communication Dilemmas Featured in the “SPARS
Pandemic 2025–2028” Scenario
Response Phase
▶ Engendering public trust and a sense of self-efficacy when a crisis is still
evolving and critical health information is incomplete
▶ Responding to public and political pressure to share information about
potential MCMs in the development pipeline even though information
may be incomplete or proprietary
▶ Maintaining trust in government processes for ensuring the timely
development of safe and effective vaccines when novel threats arise
▶ Harmonizing inconsistent messaging across health agencies
▶ Appropriately tailoring public health messages to address the concerns
and culture of specific communities
▶ Responding to the power of graphic images of a child in distress: one
story that is elevated to a population-level problem
▶ Responding to demand for an alternative antiviral drug not available in
the United States
▶ Responding to misinformation or doubt about an MCM generated by a
prominent public figure
▶ Overlooking communication platforms used by specific groups; quickly
gaining fluency and effectively engaging the public using a new media
platform
▶ Responding to public criticism about potential unequal access to MCMs
like Kalocivir
▶ Maintaining public support after changing positions on MCM safety and
efficacy
▶ Communicating the need for and reasoning behind the prioritization of
scarce resources
▶ Publicizing MCM programs and availability to promote uptake and
efficient distribution
▶ Providing real-time data on vaccine availability to align MCM supply with
public demand
▶ Maintaining consistent messaging across electronic and non-electronic
media and implementing a secondary communications plan if electronic
media are not available
▶ Addressing multiple independent MCM concerns simultaneously
▶ Meeting the information needs of citizens who come from diverse
cultural, social, and demographic backgrounds and who may have
varying degrees of trust in health authorities
▶ Supporting the current MCM product in the face of opposition from a
foreign regulatory agency
The SPARS Pandemic 2025–2028 89
▶ Responding to complex ethical issues that are beyond the United States
government’s control
▶ Responding to questions regarding safety and efficacy of drugs that have
extended shelf lives
Recovery Phase
▶ Communicating with the public about trustworthy sources of data and
options for legal recourse in a climate of mistrust
▶ Bringing a sense of resolution to a period of crisis while striking a balance
between the need to affirm collective grief/loss and the need to move
forward
▶ Institutionalizing communications lessons from the 2025–2028 SPARS
pandemic
Response Scenario Excerpt
The following excerpt from the scenario takes place early on
in the pandemic. One month previously the Food and Drug
Administration (FDA) had issued an Emergency Use Authorization
(EUA) for the antiviral Kalocivir. The drug had been evaluated as
a therapeutic for other coronavirus-caused diseases and several
million doses were maintained by the Strategic National Stockpile
(SNS), which meant the drug could be deployed as necessary while
production capacity was established to meet demand. The FDA
and CDC provided information on the drug, but some differences in their messaging caused concern among certain groups
including parents of young children. The specific communication
dilemma this excerpt considers is how to confront the power of a
single graphic image of a child in distress when one story is elevated to a population-level problem.
“Going Viral”
Reports of negative side effects associated with Kalocivir began
gaining traction in February 2026. Despite the negative response,
public health agencies continued to make forward progress until
February 22, when a video of a 3-year-old boy in North Carolina
projectile vomiting immediately after taking a dose of Kalocivir
went viral. In the video clip, the boy swallows a pediatric dose of
liquid Kalocivir, vomits profusely, chokes, and then faints in the
pool of his own vomit while his mother shrieks in the background.
90 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
This clip was widely shared across the United States with a
variety of captions including #AntiviralsDontWork, #DontTake
TheDrugs, and #NaturalCuresAreBetterThanThis. The hashtags,
in turn, provided a way for people sharing these views to find one
another and band together on social media. They formed ZapQ
and other online discussion groups, which allowed them to receive
any messages from group members via smartphones and internet
accessing technology (IAT) instantaneously as they were posted.
Some members of these ZapQ groups even began to use full-sized
(12″×12″) IAT screens on the backs of their jackets, coats, and
backpacks to loop the vomiting video for all in their immediate
vicinity to see.
The social media groundswell quickly overwhelmed the capacity of local, state, and federal agencies to respond, and compliance
with public health and medical recommendations dropped considerably. The FDA and other government agencies quickly attempted
to remind the public that correlation does not equate to causation,
and that vomiting was not a known side effect of Kalocivir. This
message, while scientifically accurate, lacked appropriate empathy
and failed to assuage the public’s mounting fears. As a result, it was
largely ignored, and public concern continued to grow.
In the following weeks, officials from the FDA, CDC, and
other government organizations attempted to promote positive,
accurate information about Kalocivir on several traditional and
social media platforms in order to quell public fear. This messaging, however, was less than optimal both in terms of timing and
dissemination. While the government took several days to provide
an emotionally appropriate message, the spread of the viral video
on social media was exponentially faster. By the time the government responded, most people across the country had already seen
the vomiting video and formed their own conclusions. Additionally, in their responses, governmental organizations were not able
to effectively access all social media platforms. ZapQ groups, for
example, had closed memberships and typically could only be
accessed via invitations from group members.
Both of these issues prompted government organizations to
improve the timing and impact of their social media responses.
While most government agencies, including the CDC and HHS,
The SPARS Pandemic 2025–2028 91
had long-established offices that were directed to coordinate social
media and other communication efforts, the protocols of individual agencies and different agency cultures led to delayed and
sometimes uncoordinated messages.
Despite the many outreach efforts by various government
officials and entities, the government was ultimately unable to
develop a suitable replacement for the initial vomiting video. By
early June 2026, the video had become the most shared Zap clip
among junior high and high school students across the country
who appreciated the shock factor of the video. As a result, the public was continually re-exposed to the anti-Kalocivir message for
several months after the initial incident and subsequent responses.
Food for Thought Questions:
- Why might communicating the science around MCM adverse
effects alone not be enough to address people’s fears and concerns about an MCM like Kalocivir? Why is it also important
to communicate with compassion, concern, and empathy? - To what extent is having sufficiently skilled staff and organizational capacity to communicate via traditional media and
social media platforms critical to influencing public debates
and awareness about an MCM like Kalocivir? - What MCM communication challenges are likely to emerge
among up-and-coming youth audiences who are avid consumers of interactive and visual forms of information?
Recovery Scenario Excerpt
The following excerpt from the scenario considers issues related
with recovery, and how to communicate with the public about
trustworthy sources of data and options for legal recourse in a climate of mistrust. At this point in the storyline, Corovax, the FDAapproved vaccine for SPARS, has been released for more than
9 months and the United States is solidly in the recovery phase
of the pandemic. SPARS is now uncommon in the US and public
focus has shifted from the disease to the potential side effects of
SPARS treatments including the Corovax vaccine.
92 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
“Vaccine Injury”
As time passed and more people across the United States were
vaccinated, claims of adverse side effects began to emerge. Several
parents claimed that their children were experiencing neurological symptoms similar to those seen among livestock exposed to
the GMI vaccine. By May 2027, parental anxiety around this claim
had intensified to the point of lawsuits. That month, a group of
parents whose children developed mental retardation as a result of
encephalitis in the wake of Corovax vaccination sued the federal
government, demanding removal of the liability shield protecting
the pharmaceutical companies responsible for developing and
manufacturing Corovax.
The growing plaintiff cohort quickly withdrew their suit upon
learning that the National Vaccine Injury Compensation Trust
Fund (NVICTF) and an emergency appropriation of funds authorized by Congress under the PREP Act existed to provide financial
reimbursement to those who were adversely affected by the Corovax vaccine in order to cover healthcare costs and other related
expenses. Given the positive reaction to the federal government’s
response and the fact that the majority of US citizens willing to
be vaccinated had already been immunized, the negative publicity
surrounding adverse reactions had little effect on nationwide vaccination rates. The focus on adverse side effects, however, resulted
in a considerable increase in the number of compensation claims
filed, and many grew concerned about the long-term effects that
Corovax could have on their health. This concern was particularly
high among some African American parents who continued to
question the government’s motives regarding the Corovax vaccination campaign.
While the FDA, CDC, and other agencies were busy researching possible connections between Corovax and the reported neurological side effects, their efforts were continually undermined by
epidemiological analyses produced by various non-governmental
individuals and groups. The popular science blogger EpiGirl, for
example, began posting interactive maps of the incidence of Corovax side effects in April 2027. To create the maps, EpiGirl collected anecdotes of adverse Corovax side effects using Facebook,
Twitter, and YouTube and combined them with data downloaded
The SPARS Pandemic 2025–2028 93
from the HHS Vaccine Adverse Event Reporting System (VAERS),
a national vaccine safety surveillance program maintained by the
CDC and FDA. EpiGirl also encouraged those among her subscribers who were Apple product users to share health data with
her via Apple’s ResearchKit and HealthKit applications. EpiGirl’s
maps were consequently shared widely in social media circles and
even included in local and national news reports.
The federal government became concerned about the validity
of EpiGirl’s anecdotal data and the widespread sharing of patient
information via the internet. EpiGirl’s data showed a significantly
higher incidence rate of nearly every reported side effect; however, federal officials believed that this was largely due to duplicate entries resulting from compiling data from multiple sources.
Additionally, EpiGirl’s data did not seek to address the cause of the
reported side effects, only the incidence rate. Publication of similar results from organizations such as Patients-Like-Me, a group
closely associated with the natural medicine movement, further
legitimized these independent reports. The government attempted
to respond to these claims through formal press releases, but these
were neither as visually appealing nor as interactive as EpiGirl’s
maps and were, therefore, largely ignored.
Food for Thought Questions: - How might advance development and testing of recovery messages that specifically address the topics of adverse side effects
and the NVICTF help improve health authorities’ ability to
respond to public distress about medical issues emerging after
an MCM campaign? What are some messages that would warrant such testing? - Despite the uncertain science about the link between Coravax
and the reported neurological symptoms, why should health
officials still communicate with compassion and genuine sympathy toward those in the vaccinated population who experience medical issues subsequent to being vaccinated? - Given growing interest in open data systems and the application of “crowd sourcing” to solve complex problems, how
94 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
might public health officials take greater advantage of two-way
communication with an interested public in the aftermath of
the SPARS outbreak? For instance, how might input and analysis from members of the public help improve adverse event
monitoring or assess the strengths and weaknesses of a specific
MCM campaign?
Crafting Scenarios: Lessons Learned
Creating the scenario described above was a months-long process
that involved many iterative steps. While the basic process of scenario development is both described above and detailed by others
including Ogilvy and Schwartz (2004), the following are offered as
lessons learned in order to assist in the development and design of
scenarios in the future:
▶ Having a project team with different academic backgrounds
(i.e., medicine, public health, and the social sciences) provided
a solid foundation for developing the premise of the future in
which the scenario would take place. Different perspectives,
disagreements, and even lively debates were essential to developing a premise that was both realistic and meaningful. This
process also provided forward momentum for the development of specific storylines.
▶ Storyboarding the timeline of events was important to maintaining coherency in the project. In the development of the
SPARS scenario, storyboarding was not a one-time process but
rather an ongoing exercise that occurred throughout scenario
development.
▶ As storyboarding was occurring, it was essential to keep in
mind the audiences for the project. In several cases, lessons
specific audiences needed to walk away with were the starting
point; the project team used these to work backward to make
sure those lessons were fully incorporated into the storyline.
▶ A focus on small details, including using supporting illustrations like newspaper and social media headlines, was necessary to make the scenario as realistic as possible. This process
The SPARS Pandemic 2025–2028 95
of “sweating the small stuff ” also provided a mechanism for
the project team to check and recheck the accuracy of the overall product.
▶ Vetting the scenario with a group of subject matter experts
was critical. In the SPARS scenario, this process helped identify dilemmas that were of particular relevance to specific
target audiences as well as detect plot holes and inaccuracies
that were necessary to fix in order for the storyline to be both
believable and useful.
▶ Finally, developing facilitator guides along with the scenario
was a way to increase the facility of the scenario as a teaching
tool.
Conclusion
Effective communication about medical countermeasures—
including drugs, devices, and biologics (e.g., vaccines)—is often
critical in emergency situations. Such communication, however, does not just happen. It must be planned and prepared for.
Prospective scenarios, like the SPARS scenario described in this
paper, offer important opportunities for communication planning
and preparation by enabling readers, both individually and in
discussion with others, to rehearse responses to communication
dilemmas; encouraging readers to envision what the next generation of best practices in MCM emergency communication may
entail, given technological and social trends such as the growing
influence of social media and increasing levels of social isolation;
and prompting readers to consider and prepare for other future
communication dilemma possibilities. In today’s world of rapidlyevolving ICT, such preparation is especially crucial.
ORCID
Emily K. Brunson https://orcid.org/0000-0001-6321-1882
Hannah Chandler https://orcid.org/0000-0003-0262-2295
Gigi Kwik Gronvall https://orcid.org/0000-0003-2514-146X
96 BRUNSON, CHANDLER, GRONVALL, RAVI, SELL, SHEARER, and SCHOCH-SPANA
Sanjana Ravi https://orcid.org/0000-0001-9769-6814
Monica Schoch-Spana https://orcid.org/0000-0002-8397-8367
Tara Kirk Sell https://orcid.org/0000-0002-8342-476X
Matthew P. Shearer https://orcid.org/0000-0002-2031-2904
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